# OKATIE PHYSICAL THERAPY AND SPORTS MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356995211
- **Authorized official:** J. ROBERT GAVIN MD (OWNER)
- **Authorized official phone:** (843) 645-2668

## Contact information

- **Practice address:** 149 RIVERWALK BLVD STE 3, RIDGELAND, SC 29936-8191
- **Practice address phone:** (843) 645-2668
- **Mailing address:** 15 MOSS CREEK VLG, HILTON HEAD, SC 29926-1105
- **Mailing address phone:** (843) 681-5077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/30/2019
- **Last updated:** 07/30/2019